🦀 PT Crab Issue 68 - I’ll See Your Meta and Raise You Meta

In the week after the big, evil, blue F corporation became the big, evil, blue and white M corporation, we’re going meta at PT Crab as well. This issue is all about looking at what we do in PT, from fear in post-op outcomes to the influence of verbal suggestions. King Crab supporters got two more articles, one about instruments for measuring satisfaction and a second about the validity of SIJ tests (and it sure surprised). Become a supporter to help PT Crab and get twice as many articles here. Overall, we’re looking at processes and methods to do things, not the things themselves. Seem confusing? It’s not, I just didn’t explain it well. What I did explain well (as usual) are the studies below.

In other news, I’m trying to collect all the PT CPGs in one, unpaywalled place. Every one I’ve found so far is open access and links to them are here along with a way you can help me catch ‘em all. Head here for details: https://ptcrab.org/clinical-practice-guidelines and to suggest any that I'm missing from the list.

With that, let’s dive in!

Don’t be afraid. Don’t be very afraid.

The Gist - This piece from the Journal of Arthroplasty makes the argument that fear is not a good thing. I don’t think any of us thought that, but they put numbers to it, which makes it even better. Specifically, they looked at 463 total joint arthroplasty patients (hip and knee) to see how anxiety, depression, and pain catastrophization scores affected their recoveries. They found that those with any of these three conditions had worse pre-op and post-op pain and function scores. Fortunately, they did improve post-operatively, and they even improved slightly more than people without these conditions, but they never got to functional levels as high as those who weren’t anxious, depressed, or catastrophizing. In these patients, objective function wasn’t worse than non-depressed etc. patients, but subjective function was, and this lowered their eventual objective function at the end of rehab. Quite interesting I’d say.

Tell Me More - There are interventions that PTs can do for these things, such as cognitive behavioral therapy techniques and reducing fear-avoidance behavior, and the way that we talk to our patients can definitely help as well. The present literature doesn’t go into that, but we’ll be covering it in the near future. There’s always referral to mental health providers too, don’t forget! In other notes, the outcome measures used in this study were the Harris Hip and Knee Society Scores. To measure anxiety, depression, and pain catastrophization, they used the Hospital Anxiety and depression scale and the Pain Catastrophization Scale. And for some numbers, the differences a year later weren’t huge, but they were there. Pain was 1.0 greater for the catastrophizers (on 0-10), and HHS/KSS were 1.3 less. Technically significant but all smaller than MCIDs for the scales involved, jsyk.

Paper? Here you are m’Lord.

You Can Reduce Pain Just By Saying The Right Thing

The Gist - A piece of clickbait, I know, but it’s based on a real paper, promise! This narrative review from researchers in Chile and Canada describes how verbal suggestion can help manage MSK pain. It’s really cool!

They explain the neurobiology of verbal suggestion and the particulars of what therapists can say to reduce pain. We’ll focus on the latter here (but the former is really good and you should read the whole paper to see it). The review discovered that positive verbal suggestion and high levels of empathy significantly favor the analgesic effect, while neutral communication can make it worse. The magnitude of these changes is controversial, but the effect seems to be there across the studies. Additionally, specific information about how the intervention will help the patient has been demonstrated to make a difference in how effective it is. So sell yourself people!

Tell Me More - Before you think it, this study is not saying that you should trick your patients. Rather, it points out how important word choice is in therapy and provides a huge reference list to that effect, one that I will certainly be reading. The major takeaway is the value of verbal suggestion about the potential for gain through a therapeutic method. There’s promising research that talking about interventions more positively leads to better outcomes.

There are some limitations to the research that the group was able to pull from. Some of the studies included had methodological limitations, like lack of a control group or heterogeneity of the subjects and treatments. This is an emerging field of study and it’s not quite there yet. I would recommend checking out the bibliography to find individual studies that you can use to guide your practice.

Paper? Comin’ up.

And that’s our week. Hope you enjoyed it and we can’t wait to be back next week. As ever, please share with friends and colleagues to help PT Crab grow. You are our marketing and we really appreciate it. And remember, I need you to help get all the CPGs. Head here to suggest any that I’m missing.

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